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In France, the growing percentage of students with reading problems calls for innovative teaching, particularly for students with serious learning difficulties. The present study was conducted on two classes with comparable reading levels: one standard sixth-grade class and one eighth-grade SEGPA class (those with learning difficulties). This study examined the effects of introducing a new teaching practice, didactique workstations, into the SEGPA class. The purpose of these workstations was to make the teaching content clearer and to promote formative assessment practices in order to improve adolescents' reading comprehension and their relationship to knowledge. The results showed that introducing this innovative teaching practice had an effect on the class group: the grade differential was reduced in a way that benefitted lower-level students. In addition to classroom effects, the workstations also changed students' relationship to knowledge. Thus, learning workstations offer great potential in working towards greater equity and inclusion.

This study was designed to analyze the significance of the recess period and "the effect of its duration" on children's daily physical activity. Thirteen pupils attending school in a rural area were monitored with accelerometers during the study weeks. The intervention consisted of modifying regularly scheduled recess period for a month. Data from two school days during the third week were recorded for analyses. Analyses indicated that, according to the recommended 2 x 15 min recess schedule, children spent on average from 16.9 [plus or minus] 5.7 min to 22.8 [plus or minus] 3.7 min each day in moderate-to-vigorous physical activity (MVPA) at recess; that is, 16.3% to 20.0% of their daily MVPA (comprised between 103.4 [plus or minus] 32.5 min and 113.9 [plus or minus] 32.5 min). This level of activity increased with the increased recess duration. A 1.2% increase of the time spent at recess resulted in a 6.6% increase of their activity (average 23% to 26.5%). It appears that a more appropriate reorganization of school schedule, including recess period and proper physical education classes, may be beneficial for school children to experience adequate amount of physical activity. (Contains 2 figures and 2 tables.) [Abstract provided in both English and French.]

In urbanized areas, rivers and riparian ecosystems are often the only ecological corridors available for wildlife movement. There, riverbanks are often stabilised by civil engineering structures (dykes, riprap). This can lead to habitat degradation and loss of landscape connectivity. Fascines (willow bundles tied together) could be an alternative to riprap, since they maintain the quality of the natural ecosystems by using native vegetal species instead of rocks, but their potential positive impact needs to be assessed. We proposed a landscape-scale decision-making method for river managers who want to restore banks by transforming riprap into fascines to improve landscape connectivity. We applied our methodology to a case study involving a 25 km-stretch of the Arve River, France. We selected four target vertebrate species based on biological traits to cover a wide range of dispersal capacities. For each species, we used landscape graphs to assess habitat connectivity under different contrasted riverbank scenarios. Scenarios included replacing all-natural banks with ripraps or replacing all ripraps with fascines. In addition, we systematically tested the effect of replacing individual 100 or 500 m sections of ripraps by fascines, to locate where riverbank restoration would maximize connectivity gain. The four species selected responded very differently to the scenarios (up to +14% and +46% change in Probability of Connectivity for common toads and Eurasian beavers, respectively, 0% for common sandpipers and barred grass snakes). The restoration of specific riverbank sections could result in important gains in PC (up to +33% for one single section for one species) but no section maximized connectivity gain for all the target species. [ABSTRACT FROM AUTHOR]

The mid-infrared lightweight tunable diode laser hygrometer, "Pico-Light H 2 O", the successor to Pico-SDLA H 2 O, is presented and its performances are evaluated during the AsA 2022 balloon-borne intercomparison campaign conducted at the CNES Aire-sur-l'Adour (AsA, 43.70° N; 0.25° W) balloon launch facility and the Aeroclub d'Aire-sur-l'Adour in France. The Pico-Light instrument has primarily been developed for sounding of the upper troposphere and stratosphere, although during the AsA 2022 campaign we expand the range of comparison to include additionally the lower troposphere. Three different types of hygrometer and two models of radiosonde were flown, operated by the French Space Agency (CNES) and the NOAA Global Monitoring Laboratory (GML) scientific teams: Pico-Light H 2 O, the NOAA Frost Point Hygrometer (FPH), the micro-hygrometer (in an early phase of development), and M20 and iMet-4 sondes. Within this framework, we intend to validate measurements of Pico-Light H 2 O through a first intercomparison with the NOAA FPH instrument. The in situ monitoring of water vapour in the upper troposphere–lower stratosphere continues to be very challenging from an instrumental point of view because of the very small amounts of water vapour to be measured in these regions of the atmosphere. Between the lapse rate tropopause (11–12.3 km) and 20 km, the mean relative difference between water vapour mixing ratio measurements by Pico-Light H 2 O and NOAA FPH was 4.2 % ± 7.7 %, and the mean tropospheric difference was 3.84 % ± 23.64 %, with differences depending on the altitude range considered. In the troposphere, relative humidity (RH) over water comparisons led to agreement between Pico-Light and NOAA FPH of - 0.2 % on average, with excursions of about 30 % RH due to moisture variability. Expanding the comparison to meteorological sondes, the iMet-4 sondes agree well with both Pico-Light and FPH between the ground and 7.5 km (within ± 3 % RH), as do the M20 sondes, up to 13 km, which are wet-biased by 3 % RH and dry-biased by 20 % in cases of saturation. [ABSTRACT FROM AUTHOR]

Objective To validate the predictive value of the DAS28 γ-glutamyl transferase (DAS28-γGT) for the occurrence of major cardiovascular (CV) events (MACE) in the 'Etude et Suivi des Polyarthrites Indifférenciées Récentes' ESPOIR cohort. Methods Analysis of 13-year outcome from the ESPOIR cohort. RA patients with missing data for baseline γGT activity and those not followed-up to 1 year were excluded. Baseline DAS28-γGT was calculated using the following formula: 0.56*√TJ-28 + 0.28 * √SJ-28 + 2*ln(γGT) + 0.014 * GH. Our primary outcome was the merit of the DAS28-γGT in predicting the occurrence of MACE. Results Among the 696 patients [536 women, mean (s. d.) age of 49 (12) years], 34 MACE were recorded, with a mean time to event of 71 (44) months. Receiver operating characteristic curve analysis indicated that a DAS28-γGT >9.4 had the best sensitivity and specificity for the diagnosis of MACE during the observation period. DAS28-γGT >9.4 was predictive of the occurrence of MACE, with a hazard ratio (HR) of 3.11 (95% CI 1.41, 5.43). Multivariate Cox analyses confirmed higher DAS28-γGT (HR 2.44, 95% CI 1.05, 5.64) together with age (HR 1.04, 95% CI 1.01, 1.07) and diabetes mellitus (HR 4.12, 95% CI 1.55, 10.95) as independent predictors of MACE. There was a dose effect of the DAS28-γGT for MACE-risk prediction, which was in line with the application of the Framingham risk score. Conclusion The DAS28-γGT was identified in this large prospective cohort as an independent predictor of MACE in patients with RA. The DAS28-γGT is a simple and useful tool to evaluate CV risk in routine and warn the clinician about the CV risk burden in patients with RA. [ABSTRACT FROM AUTHOR]

Objective: Psychosocial adjustment can be challenging for children with cleft lip with or without a cleft palate (CL ± P). Previous studies have linked social integration with self-acceptance and highlighted the impact of the parents' stress on self-acceptance. Teasing can be linked to children having difficulties explaining their diagnosis to others. This prospective research aimed to gain a better understanding of family communication about cleft, children's oral storytelling about their cleft, and explore their self-image and perceived familial acceptance. Participants: Parents and their children with CL ± P (N = 54; average age: 5.6 years). Design: Semistructured interviews with parents and structured interviews with children were conducted regarding their oral storytelling focusing on scars from cleft lip surgery. Children completed a projective test to explore their self-image and perceptions of familial acceptance. Language screening was completed with the French Wechsler Preschool Primary Scale of Intelligence-Fourth Edition. Results: Only 30% of children explained their cleft in a way appropriate for peers, including presence at birth, having had surgery, and scar location. Children's ability to explain their cleft was not related to language performance, which was in the average range of 84%. Children's cleft explanations were dependent on parents' narratives and education methods, including the use of verbal explanations and preoperative photographs. Children's storytelling was related to their self-image and perceived parental acceptance. Conclusion: Cleft teams should assist families in building their cleft story based on a complete explanation with photographs and a positive and accepting approach. [ABSTRACT FROM AUTHOR]

Background: Biological studies suggested that the COVID-19 outbreak in France occurred before the first official diagnosis on January 24, 2020. We investigated this controversial topic using a large collection of chest CTs performed throughout French emergency departments within 6 months before the 1st lockdown. Results: Overall, 49,311 consecutive patients (median age: 60 years, 23,636/49,311 [47.9%] women) with available chest CT images and reports from 61 emergency departments between September 1, 2020, and March 16, 2020 (day before the 1st French lockdown), were retrospectively included in this multicentre study. In the macroscopic analysis of reports automatically (labelled for presence of ground glass opacities [GGOs], reticulations, and bilateral and subpleural abnormalities), we found a significant breakpoint on February 17, 2020, for the weekly time series with 1, 2 and ≥ 3 of these 4 radiological features, with 146/49,311 (0.3%) patients showing bilateral abnormalities and ground glass opacities (GGOs) from that day. According to radiologists, 22/146 (15.1%) CT images showed typical characteristics of COVID-19, including 4/146 (2.7%) before February 2020. According to hospital records, one patient remained without microbial diagnosis, two patients had proven influenza A and one patient had concomitant influenza A and mycoplasma infection. Conclusion: These results suggest that SARS-CoV-2 was not circulating in the areas covered by the 61 emergency departments involved in our study before the official beginning of the COVID-19 outbreak in France. In emergency patients, the strong resemblance among mycoplasma, influenza A and SARS-CoV-2 lung infections on chest CT and the nonspecificity of CT patterns in low prevalence periods is stressed. Critical relevance statement: We proposed here an innovative approach to revisit a controversial 'real' start of the COVID-19 pandemic in France based on (1) a population-level approach combining text mining, time series analysis and an epidemiological dataset and (2) a patient-level approach with careful retrospective reading of chest CT scans complemented by analysis of samples performed contemporarily to the chest CT. We showed no evidence that SARS-CoV-2 was actively circulating in France before February 2020. Key points: 1. Emergency teleradiology databases enable both population-level and patient-level analyses and facilitate revisiting the beginning of the COVID-19 pandemic. 2. The rates of typical COVID-19 chest CTs did not increase before February 2020. 3. Typical COVID-19 chest CTs before February 2020 were diagnosed as influenza A and mycoplasma pneumonia. [ABSTRACT FROM AUTHOR]

Purpose: The present study aimed at assessing the prevalences of post-traumatic stress disorder (PTSD) (main objective), anxiety, depression, and burnout syndrome (BOS) and their associated factors in intensive care unit (ICU) staff workers in the second year of the COVID-19 pandemic. Materials and methods: An international cross-sectional multicenter ICU-based online survey was carried out among the ICU staff workers in 20 ICUs across 3 continents. ICUs staff workers (both caregivers and non-caregivers) were invited to complete PCL-5, HADS, and MBI questionnaires for assessing PTSD, anxiety, depression, and the different components of BOS, respectively. A personal questionnaire was used to isolate independent associated factors with these disorders. Results: PCL-5, HADS, and MBI questionnaires were completed by 585, 570, and 539 responders, respectively (525 completed all questionnaires). PTSD was diagnosed in 98/585 responders (16.8%). Changing familial environment, being a non-caregiver staff worker, having not being involved in a COVID-19 patient admission, having not been provided with COVID-19-related information were associated with PTSD. Anxiety was reported in 130/570 responders (22.8%). Working in a public hospital, being a woman, being financially impacted, being a non-clinical healthcare staff member, having no theoretical or practical training on individual preventive measures, and fear of managing COVID-19 patients were associated with anxiety. Depression was reported in 50/570 responders (8.8%). Comorbidity at risk of severe COVID-19, working in a public hospital, looking after a child, being a non-caregiver staff member, having no information, and a request for moving from the unit were associated with depression. Having received no information and no adequate training for COVID-19 patient management were associated with all 3 dimensions of BOS. Conclusion: The present study confirmed that ICU staff workers, whether they treated COVID-19 patients or not, have a substantial prevalence of psychological disorders. [ABSTRACT FROM AUTHOR]

In this study, we use a synergy of in situ and remote sensing measurements collected during the SOuthwest FOGs 3D experiment for processes study (SOFOG3D) field campaign in autumn and winter 2019–2020 to analyse the thermodynamic and turbulent processes related to fog formation, evolution, and dissipation across southwestern France. Based on a unique measurement dataset (synergy of cloud radar, microwave radiometer, wind lidar, and weather station data) combined with a fog conceptual model, an analysis of the four deepest fog episodes (two radiation fogs and two advection–radiation fogs) is conducted. The results show that radiation and advection–radiation fogs form under deep and thin temperature inversions, respectively. For both fog categories, the transition period from stable to adiabatic fog and the fog adiabatic phase are driven by vertical mixing associated with an increase in turbulence in the fog layer due to mechanical production (turbulence kinetic energy (TKE) up to 0.4 m 2 s -2 and vertical velocity variance (σw2) up to 0.04 m 2 s -2) generated by increasing wind and wind shear. Our study reveals that fog liquid water path, fog top height, temperature, radar reflectivity profiles, and fog adiabaticity derived from the conceptual model evolve in a consistent manner to clearly characterise this transition. The dissipation time is observed at night for the advection–radiation fog case studies and after sunrise for the radiation fog case studies. Night-time dissipation is driven by horizontal advection generating mechanical turbulence (TKE at least 0.3 m 2 s -2 and σw2 larger than 0.04 m 2 s -2). Daytime dissipation is linked to the combination of thermal and mechanical turbulence related to solar heating (near-surface sensible heat flux larger than 10 W m -2) and wind shear, respectively. This study demonstrates the added value of monitoring fog liquid water content and depth (combined with wind, turbulence, and temperature profiles) and diagnostics such as fog liquid water reservoir and adiabaticity to better explain the drivers of the fog life cycle. [ABSTRACT FROM AUTHOR]

Background Except for cryptococcosis, fungal infection of the central nervous system (FI-CNS) is a rare but severe complication. Clinical and radiological signs are non-specific, and the value of conventional mycological diagnosis is very low. This study aimed to assess the value of β1,3-D-glucan (BDG) detection in the cerebrospinal fluid (CSF) of non-neonatal non-cryptococcosis patients. Methods Cases associated with BDG assay in the CSF performed in 3 French University Hospitals over 5 years were included. Clinical, radiological, and mycological results were used to classify the episodes as proven/highly probable, probable, excluded, and unclassified FI-CNS. Sensitivity and specificity were compared to that calculated from an exhaustive review of the literature. Results In total, 228 episodes consisting of 4, 7, 177, and 40 proven/highly probable, probable, excluded, and unclassified FI-CNS, respectively, were analysed. The sensitivity of BDG assay in CSF to diagnose proven/highly probable/probable FI-CNS ranged from 72.7% [95% confidence interval {CI}: 43.4%‒90.2%] to 100% [95% CI: 51%‒100%] in our study and was 82% in the literature. For the first time, specificity could be calculated over a large panel of pertinent controls and was found at 81.8% [95% CI: 75.3%‒86.8%]. Bacterial neurologic infections were associated with several false positive results Conclusions Despite its sub-optimal performance, BDG assay in the CSF should be added to the diagnostic armamentarium for FI-CNS. [ABSTRACT FROM AUTHOR]

Background: Data are limited regarding the combined impact of headache frequency and failure of preventive medication (efficacy and/or tolerability) on the humanistic/economic burden of migraine. Methods: A retrospective, cross-sectional analysis of 2020 National Health and Wellness Survey (NHWS) data was conducted. An opt-in online survey identified adults in France, Germany, Italy, Spain, and United Kingdom with self-reported physician-diagnosed migraine. Participants with ≥ 4 monthly headache days (MHDs) were stratified by prior preventive medication use/failure (preventive naive; 0–1 failure; ≥ 2 failures). Quality-of-life and economic outcomes were compared among groups using generalized linear modeling. Results: Among individuals with ≥ 4 MHDs (n = 1106), the NHWS identified 298 (27%) with ≥ 2 failures, 308 (28%) with 0–1 failure, and 500 (45%) as preventive naive. Individuals with ≥ 2 failures versus preventive-naive individuals had significantly lower scores on the 12-Item Short Form Survey Physical Component Summary (42.2 vs 44.1; P < 0.005), numerically higher scores on the Mental Component Summary (39.5 vs 38.5; P = 0.145), significantly higher scores on the Migraine Disability Assessment (39.1 vs 34.0; P < 0.05), and significantly higher prevalence of depression symptoms (62% vs 47%; P < 0.001) and anxiety symptoms (42% vs 31%; P < 0.01). The ≥ 2 failures group versus the preventive-naive group also had significantly more functional impairment as assessed by mean numbers of migraine-specific missed work days (7.8 vs 4.3) and household activities days (14.3 vs 10.6) in the past 6 months (P < 0.001) as well as the prevalence of absenteeism (19% vs 13%), overall work impairment (53% vs 42%), and activity impairment (53% vs 47%) (all P < 0.05). Emergency department visits (0.7 vs 0.5; P = 0.001) and hospitalizations (0.5 vs 0.3; P < 0.001) in the past 6 months were significantly higher in the ≥ 2 failures group versus the preventive-naive group, while indirect costs (€13,720 vs €11,282) and the proportion of individuals with non-adherence during the past 7 days (73% vs 64%) were numerically higher. Conclusions: Increased burden, quality-of-life impairment, and functional impairment exist among individuals with migraine experiencing ≥ 4 MHDs and more treatment failures. While cause and directionality cannot be determined, these results suggest the need for effective preventive migraine treatments. [ABSTRACT FROM AUTHOR]

Introduction: To evaluate real-world efficacy, safety, and treatment patterns with the dexamethasone intravitreal implant (DEX) in diabetic macular edema (DME) in France. Methods: In this prospective, multicenter, observational, noncomparative, post-reimbursement study, consecutively enrolled patients with DME had a baseline evaluation on day 0. Those treated with DEX on day 0 were to be reevaluated at week 6 and months 6, 12, 18, and 24. DEX retreatment and/or alternative therapies were allowed during follow-up. The primary outcome measure was the maximum best corrected visual acuity (BCVA) gain from baseline during follow-up. Secondary outcome measures included time to maximum BCVA gain, patients (%) with prespecified BCVA gains from baseline at each visit, maximum central retinal thickness (CRT) reduction from baseline, patients (%) with CRT reduction ≥ 20% from baseline at each visit, patients (%) with DME resolution (per investigator judgement), and adverse events (AEs). Results: Of 112 patients/eyes with DME for 3.5 years (mean) at baseline, 80 (including 86.1% previously treated) received DEX on day 0 and were analyzed for efficacy. Early study termination precluded collection of ≥ 12-month efficacy data. Patients received 1.4 DEX injections over 8.3 months (averages). The maximum BCVA gain from baseline was 3.6 letters, reached after 77.2 days (averages); 24.6% (week 6) and 15.0% (month 6) of patients experienced ≥ 10-letter BCVA gains from baseline. The mean maximum CRT reduction from baseline was −146.4 µm; 61.4% (week 6) and 36.0% (month 6) of patients had CRT reductions ≥ 20% from baseline, and 68.1% reported DME resolution at least once during follow-up. Ocular hypertension (n = 8, 12.1%) was the most frequent treatment-related AE. Conclusions: LOUVRE 3 confirmed that DEX improves BCVA and CRT, even in a patient population that had predominantly received DEX before enrollment in the study, and showed that DME resolution was observed during follow-up. DEX tolerability was consistent with published data, supporting treatment benefits in DME. ClinicalTrials.gov Identifier: NCT03003416. [ABSTRACT FROM AUTHOR]

Cloud radars are capable of providing continuous high-resolution observations of clouds and now offer new capabilities within fog layers thanks to the development of frequency-modulated continuous-wave 95 GHz cloud radars. These observations are related to the microphysical properties of clouds. Power law relations in the form of Z=a⋅LWCb are generally used to estimate liquid water content (LWC) profiles. The constants a and b from the power law relation vary with the cloud type and cloud characteristics. Due to the variety of such parameterizations, selecting the most appropriate Z –LWC relation for a continuous cloud system is complicated. Additional information such as liquid water path (LWP) from a co-located microwave radiometer (MWR) is used to scale the LWC of the cloud profile. An algorithm for estimating the LWC of fog and warm clouds using 95 GHz cloud radar–microwave radiometer synergy in a variational framework is presented. This paper also aims to propose an algorithm configuration that retrieves the LWC of clouds and fog using radar reflectivity and a climatology of the power law parameters. To do so, variations in the scaling factor ln⁡a (the logarithm of pre-factor a from power law relation) when MWR observations are available are allowed in each cloud profile to build a climatology of the scaling factor ln⁡a that can be used when MWR observations are not available. The algorithm also accounts for attenuation due to cloud droplets. In this algorithm formulation, the measure of uncertainty in the observations, the forward model, and the a priori information of desired variables acts as weights in the retrieved quantities. These uncertainties in the retrieval are analyzed in the sensitivity analysis of the algorithm. The retrieval algorithm is first tested on a synthetic profile for different perturbations in sensitivity parameters. The sensitivity study has shown that this method is susceptible to LWP information because LWP is point information for the whole cloud column. By further investigating the sensitivity analysis of various biases in LWP information, it was found that it is beneficial to incorporate LWP, even if it is biased, rather than not assimilate any LWP. The algorithm is then implemented in various cloud and fog cases at the SIRTA observatory to estimate LWC and the scaling factor. The scaling factor (ln⁡a) changes for each cloud profile, and the range of ln⁡a is consistent with suggested values in the literature. The validation of such an algorithm is challenging, as we need reference measurements of LWC co-located with the retrieved values. During the SOFOG-3D campaign (southwest of France, October 2019 to March 2020), in situ measurements of LWC were collected in the vicinity of a cloud radar and a microwave radiometer, allowing comparison of retrieved and measured LWC. The comparison demonstrated that the cloud–fog heterogeneity played a key role in the assessment. The proposed synergistic retrieval algorithm is applied to 39 cloud and fog cases at SIRTA, and the behavior of the scaling factor is studied. This statistical analysis of scaling is carried out to develop a radar-only retrieval method. The climatology revealed that the scaling factor can be linked to the maximum reflectivity of the profile. From climatology, the statistical relations for the scaling factor are proposed for fog and clouds. Thanks to the variational framework, a stand-alone radar version of the algorithm is adapted from the synergistic retrieval algorithm, which incorporates the climatology of the scaling factor as a priori information to estimate the LWC of warm clouds. This method allows the LWC estimation using only radar reflectivity and climatology of the scaling factor. [ABSTRACT FROM AUTHOR]

In France, midwives are a medical profession with defined competences and operate autonomously only in eutocia, where their responsibility is full and complete. The recent extension of their field of competence to gynecology, orthogeny and ultrasound creates new problems and requires an adapted and effective initial training. The aim of this article is to describe the legal liability of midwife during childbirth according to their place of practice (i.e. public or private institution). In the public sector, midwives are allowed to perform low-risk eutocic childbirths without physician assistance. However, the ultimate person in charge of the delivery room is the obstetrician-gynecologist (OB-GYN). This is problematic in terms of sharing information, especially when the doctor is on-call with longer response of intervention. It is then necessary to analyze the schedule, the content and methods of the shifts or the telephone calls, the traceability of which is often difficult. In the private sector, the midwife, except in special cases, works under the responsibility of the OB-GYN who is fully responsible for his patients. The development of new modalities of practice exposes them to manage extremely complex situations, especially when transferring patients to hospital in case in medical indication. It seems very difficult to determine at what precise moment the responsibility passed from the independent midwife to the establishment. This will be even more if this activity has not always been approved by all the hospital staff concerned. Finally, the revival of home births or even births without medical assistance brings back complications that we thought definitively forgotten and raises extremely complex questions of responsibility. [ABSTRACT FROM AUTHOR]

Transit time can be estimated thanks to natural tracers, but few of them are usable in the 0–6-month range. The main purpose of this work is to analyze the potential of the ratio of heavy- to light-weight organic compounds (the humification index (HIX); Ohno, 2002; Zsolnay et al., 1999) as a natural tracer of short transit time (Blondel et al., 2012). Critical analysis of former studies shows that although the link between HIX and transit time seems consistent, the whole methodological approach needs to be consolidated. Natural organic matter fluorescence from 289 groundwater samples from four springs and 10 flow points located in the unsaturated zone of the Vaucluse karst system is characterized by parallel factor analysis (PARAFAC) thanks to the excitation–emission matrix (EEM), thus (i) allowing for the identification of main fluorescent compounds of sampled groundwater and (ii) evidencing the inadequacy of HIX 2D emission windows to characterize groundwater organic matter. We then propose a new humification index called the Transit Time index (TTi) based on the Ohno (2002) formula but using PARAFAC components of heavy and light organic matter from our samples instead of 2D windows. Finally, we evaluate TTi relevance as a transit time tracer by (i) performing a detailed analysis of its dynamics on a selected spring (Millet) and (ii) comparing its mean value over karst springs of the Vaucluse karst system. Principal component analysis (PCA) of TTi and other hydrochemical parameters monitored at Millet spring put in relief the different ranges of transit time associated with the different organic matter compounds. PCA results also provide evidence that TTi can detect a small proportion of fast infiltration water within a mix, while other natural tracers of transit time provide no or less sensitive information. TTi distributions at monitored karst springs are consistent with relative transit times expected for the small-scale, short average transit time systems. TTi thus appears as a relevant qualitative tracer of transit time in the 0–6-month range where existing tracers fail and may remain applicable, even in the case of anthropic contamination thanks to PARAFAC modeling. Transforming it into quantitative information is a challenging task which may be possible thanks to intensive studies of organic matter degradation kinetics in natural waters with the help of radiogenic isotope usage or an artificial tracer test. [ABSTRACT FROM AUTHOR]

The objective of this study was to compare the mental well-being of French women who were and were not pregnant during the first COVID-19 pandemic lockdown. We performed a nationwide online quantitative survey including all women between 18 and 45 years of age during the second and third weeks of global lockdown (25 March–7 April 2020). The main outcome measure was mental well-being measured by the Warwick–Edinburgh Mental Well-Being Scale (WEMWBS). This study analysed 275 responses from pregnant women and compared them with those from a propensity score–matched sample of 825 non-pregnant women. In this French sample, the median WEMWBS score was 49.0 and did not differ by pregnancy status. Women living in urban areas reported better well-being, while those with sleep disorders or who spent more than an hour a day watching the news reported poorer well-being. During the first lockdown in France, women had relatively low mental well-being scores, with no significant difference between pregnant and non-pregnant women. More than ever, health-care workers need to find a way to maintain their support for women's well-being. Minor daily annoyances of pregnancy, such as insomnia, should not be trivialised because they are a potential sign of poor well-being. [ABSTRACT FROM AUTHOR]

Introduction: To evaluate real-life efficacy, safety, and treatment patterns with the dexamethasone intravitreal implant (DEX) in posterior segment inflammation due to non-infectious uveitis (treatment-naïve or not) in French clinics. Methods: In this prospective, multicenter, observational, non-comparative, post-reimbursement study, consecutive patients with posterior segment inflammation due to non-infectious uveitis were enrolled and evaluated at baseline (day 0). Those who received DEX on day 0 were re-evaluated at months 2, 6, and 18. Retreatment with DEX and/or alternative therapies was allowed during follow-up. Primary outcome: patients (%) with at least a 15-letter gain in best corrected visual acuity (BCVA) at 2 months. Secondary outcomes included patients (%) with at least 15-letter BCVA gains at 6 and 18 months; mean BCVA change from baseline at 2, 6, and 18 months; and patients (%) retreated, mean central retinal thickness (CRT), and adverse events (AEs) at all post-baseline visits. Results: Ninety-seven of 245 enrolled patients with posterior segment inflammation due to non-infectious uveitis (80% previously treated) and disease duration of 5 years (average) received DEX on day 0 and were included in efficacy analyses. At month 2 (n = 91), 20.5% of patients (95% CI 12.0–28.9) gained at least 15 letters from a baseline mean of 60.9 letters; the mean gain was 6.2 letters (95% CI 3.5–8.9). At month 6, 50.0% (n = 38/76) of patients did not receive alternative treatment or DEX retreatment, mostly because inflammation had sufficiently subsided (n = 27/38, 71.1%). Although early study termination prevented efficacy analysis at 18 months (n = 12), CRT reductions persisted throughout follow-up. From baseline to month 18, 21/245 (8.6%) patients had DEX-related AEs; 17/245 (6.9%) had ocular hypertension (most common AE). Conclusion: LOUVRE 2 confirms DEX efficacy on visual acuity and CRT in predominantly DEX-pretreated patients with relatively old/stabilized uveitis. DEX tolerability was consistent with known/published data, confirming treatment benefits in posterior segment inflammation due to non-infectious uveitis. ClinicalTrials.gov Identifier: NCT02951975. [ABSTRACT FROM AUTHOR]

Background: Spread of resistant bacteria causes severe morbidity and mortality. Stringent control measures can be expensive and disrupt hospital organization. In the present study, we assessed the effectiveness and cost-effectiveness of control strategies to prevent the spread of Carbapenemase-producing Enterobacterales (CPE) in a general hospital ward (GW). Methods: A dynamic, stochastic model simulated the transmission of CPE by the hands of healthcare workers (HCWs) and the environment in a hypothetical 25-bed GW. Input parameters were based on published data; we assumed the prevalence at admission of 0.1%. 12 strategies were compared to the baseline (no control) and combined different prevention and control interventions: targeted or universal screening at admission (TS or US), contact precautions (CP), isolation in a single room, dedicated nursing staff (DNS) for carriers and weekly screening of contact patients (WSC). Time horizon was one year. Outcomes were the number of CPE acquisitions, costs, and incremental cost-effectiveness ratios (ICER). A hospital perspective was adopted to estimate costs, which included laboratory costs, single room, contact precautions, staff time, i.e. infection control nurse and/or dedicated nursing staff, and lost bed-days due to prolonged hospital stay of identified carriers. The model was calibrated on actual datasets. Sensitivity analyses were performed. Results: The baseline scenario resulted in 0.93 CPE acquisitions/1000 admissions and costs 32,050 €/1000 admissions. All control strategies increased costs and improved the outcome. The efficiency frontier was represented by: (1) TS with DNS at a 17,407 €/avoided CPE case, (2) TS + DNS + WSC at a 30,700 €/avoided CPE case and (3) US + DNS + WSC at 181,472 €/avoided CPE case. Other strategies were dominated. Sensitivity analyses showed that TS + CP might be cost-effective if CPE carriers are identified upon admission or if the cases have a short hospital stay. However, CP were effective only when high level of compliance with hand hygiene was obtained. Conclusions: Targeted screening at admission combined with DNS for identified CPE carriers with or without weekly screening were the most cost-effective options to limit the spread of CPE. These results support current recommendations from several high-income countries. [ABSTRACT FROM AUTHOR]

Background Early diagnosis and prompt initiation of specific antifungal treatment are essential for improving the prognosis of mucormycosis. We aimed to assess the performance of serum Mucorales quantitative polymerase chain reaction (qPCR) for the early diagnosis and follow-up of mucormycosis. Methods We prospectively enrolled 232 patients with suspicion of invasive mold disease, evaluated using standard imaging and mycological procedures. Thirteen additional patients with proven or probable mucormycosis were included to analyze DNA load kinetics. Serum samples were collected twice-a-week for Mucorales qPCR tests targeting the Mucorales genera Lichtheimia , Rhizomucor , and Mucor/Rhizopus. Results The sensitivity was 85.2%, specificity 89.8%, and positive and negative likelihood ratios 8.3 and 0.17, respectively in this prospective study. The first Mucorales qPCR-positive serum was observed a median of 4 days (interquartile range [IQR], 0–9) before sampling of the first mycological or histological positive specimen and a median of one day (IQR, −2 to 6) before the first imaging was performed. Negativity of Mucorales qPCR within seven days after liposomal-amphotericin B initiation was associated with an 85% lower 30-day mortality rate (adjusted hazard ratio = 0·15, 95% confidence interval [.03–.73], P  = .02). Conclusions Our study argues for the inclusion of qPCR for the detection of circulating Mucorales DNA for mucormycosis diagnosis and follow-up after treatment initiation. Positive results should be added to the criteria for the consensual definitions from the European Organization for the Research and Treatment of Cancer/Mycoses Study Group Education and Research Consortium (EORTC/MSGERC), as already done for Aspergillus PCR. [ABSTRACT FROM AUTHOR]

Objectives: (i) to create a shortened version of the Action Research Arm Test scale, (ii) to investigate its psychometric properties compared to the original scale and (iii) to externally validate it within an independent cohort. Design: Prospective longitudinal cohort study. Settings: Two University Hospitals (France, Switzerland). Participants: 47 patients with poststroke motor deficits of the upper limb coming from two different sites were included and divided into two cohorts (n = 22 for the construction cohort; n = 25 for the validation cohort). Main Measures: We used the first cohort to build the Mini-ARAT by shortening the Action Research Arm Test scale on the basis of ceiling/floor effects and collinearity of the subscales. We studied its reliability, validity, and responsiveness and performed an external validation with the second cohort. Results: The Mini-ARAT consisted of 2 subscales from the original Action Research Arm Test scale (Grip and Pinch). Internal consistency (α = 87) and inter-rater reliability (0.99, 95% CI: 0.98–0.99, p < 0.01) were good and similar to those of the Action Research Arm Test scale. The Minimal Clinically Important Difference of the Mini-ARAT was 9 points. The predictive validity in the construction and validation cohorts showed good correlation between the Mini-ARAT at baseline and the Fugl Meyer at 3 months (rho, 95% CI: 0.77, 0.49–0.90, p < 0.01, and 0.58, 0.19–0.96, p < 0.01). Conclusion: The Mini-ARAT is a time-effective tool able to capture the dynamics of motor deficits with high reliability and consistency, providing excellent information about residual motor functions, which is critically important for clinical and research purposes. [ABSTRACT FROM AUTHOR]

Background: Excess exposure to norepinephrine can compromise microcirculation and organ function. We aimed to assess the association between norepinephrine exposure and acute kidney injury (AKI) and intensive care unit (ICU) mortality after cardiac surgery. Methods: This retrospective observational study included adult patients who underwent cardiac surgery under cardiopulmonary bypass from January 1, 2008, to December 31, 2017, at the Amiens University Hospital in France. The primary exposure variable was postoperative norepinephrine during the ICU stay and the primary endpoint was the presence of AKI. The secondary endpoint was in-ICU mortality. As the cohort was nonrandom, inverse probability weighting (IPW) derived from propensity scores was used to reduce imbalances in the pre- and intra-operative characteristics. Results: Among a population of 5053 patients, 1605 (32%) were exposed to norepinephrine following cardiac surgery. Before weighting, the prevalence of AKI was 25% and ICU mortality 10% for patients exposed to norepinephrine. Exposure to norepinephrine was estimated to be significantly associated with AKI by a factor of 1.95 (95% confidence interval, 1.63–2.34%; P < 0.001) in the IPW cohort and with in-ICU mortality by a factor of 1.54 (95% confidence interval, 1.19–1.99%; P < 0.001). Conclusion: Norepinephrine was associated with AKI and in-ICU mortality following cardiac surgery. While these results discourage norepinephrine use for vasoplegic syndrome in cardiac surgery, prospective investigations are needed to substantiate findings and to suggest alternative strategies for organ protection. [ABSTRACT FROM AUTHOR]

Background: The accuracy and reliability of rapid diagnostic tests are critical for monitoring and diagnosing SARS-CoV-2 infection in the general population. This study aimed to evaluate the analytical performance of the BIOSYNEX COVID-19 Ag BSS (Biosynex Swiss SA, Fribourg, Switzerland) antigen rapid diagnostic test (BIOSYNEX Ag-RDT), which targets the SARS-CoV-2 N-nucleocapsid protein for the diagnosis of COVID-19. The Ag-RDT was compared with a real-time RT-PCR (rtRT-PCR) as gold standard for performance measurement. Methods: Two nasopharyngeal flocked swabs were prospectively collected simultaneously in March and April 2021 from 967 individuals aged ≥ 18 years tested for SARS-CoV-2 in two private laboratories, Paris, France. Results: Overall, the Ag-RDT demonstrated high sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 81.8%, 99.6%, 96.6%, and 97.5%, respectively. The agreement (97.0%), reliability assessed using Cohen's κ-coefficient (0.87), and accuracy evaluated using Youden index (J) (81.6%) in detecting SARS-CoV-2 were high. The analytical performance of the Ag-RDT remained high when there was significant viral shedding (i.e., N gene Ct values ≤ 33 on reference RT-PCR). The sensitivity was only 55.2% in case of low or very low viral excretion (Ct > 33). Conclusions: The BIOSYNEX Ag-RDT is a promising, potentially simple diagnostic tool, especially in symptomatic COVID-19 patients with substantial viral excretion in the nasopharynx. [ABSTRACT FROM AUTHOR]

Purpose: To define based on expert opinion and practical experience using a systematic and scientific approach, (1) the perceived most effective exercise-based strategies to prevent muscle injury in elite footballers; and, (2) when and how these exercise programs are prescribed based on the number of days between games i.e. implementation strategy. Methods: A Delphi survey obtained opinions and assessed for agreement. Delphi respondents consisted of 21 experienced sports practitioners (12 ± 5.3 years in elite football and with an academic background) belonging to 18 teams from the Big-5 European football leagues; England, France, Germany, Italy, Spain. Three teams were represented collaboratively by two experts. The Delphi process involves sequential rounds each evolving based on the responses from the previous. The number of rounds is not pre-defined and continues until an agreement is either achieved or it is clear that no agreement will be reached. Frequency of responses was recorded where the agreement was sought (i.e. in closed questions) and an agreement was achieved if ≥ 13/18 (70%) respondents agreed. For open-ended questions, a qualitative content analysis was performed to identify recurring themes and when themes were specified by ≥ 13 (70%), these were also considered as reaching an agreement. Practitioners had the opportunity to raise concerns if they disagreed with the 'agreement from recurrent themes'. Results: There were four Delphi rounds (100% response for each round). Sprinting and High-Speed Running (HSR) focused exercises were agreed as most effective (perceived) to prevent muscle injuries. Eccentric exercise was perceived as the next most effective. It was agreed that sprinting and HSR be integrated into coaches training, and target 100% of players worst-case match scenario (e.g. volume, intensity) based on individual maximum speeds. Eccentric exercise was recommended to be implemented according to the context of the main football session and planned/actual sprinting and HSR content. It was agreed that eccentrics can be performed before or after training, context dependent. The day to perform specific sprinting and HSR or eccentric exercises depended on the proximity of previous and upcoming matches. Other exercises reaching agreement as 'somewhat effective' included concentric and isometric, horizontal and vertical plyometrics, coordination, core and dynamic flexibility in addition to core stability. No agreement was reached for multi-joint, resisted sprinting, kicking or agility exercises nor simultaneous single-leg strength and stability. Finally, no agreement was reached regarding programming variables e.g. sets, repetitions as deemed too contextual. Conclusion: Regarding exercise-based strategies, particular importance agreed by the Delphi expert group was to focus on sprinting, HSR and eccentric exercises, integrated with a variety of other exercise modes which also carry some level of effectiveness in a multidimensional programme. Context was agreed to be key and decision-making about when to undertake/ how to prescribe exercise strategies to be made according to the content of normal football training and the proximity of matches. [ABSTRACT FROM AUTHOR]

Background: As part of a decades-long process of restructuring primary care, independent (also known as community) healthcare workers are being encouraged to work in groups to facilitate their coordination and continuity of care in France. French independent midwives perform about half of the early prenatal interviews that identify mothers' needs during pregnancy and then refer them to the appropriate resources. The French government, however, structured the COVID-19 pandemic response around public health institutions and did not directly mobilise these community healthcare workers during the lockdown phase. These responses have raised questions about their role within the healthcare system in crises. This survey's main objectives were to estimate the proportion of independent midwives who experienced new difficulties in referring women to healthcare facilities or other caregivers and in collaborating with hospitals during the first stage of this pandemic. The secondary objective was to estimate the proportion, according to their mode of practice, of independent midwives who considered that all the women under their care had risked harm due to failed or delayed referral to care.Methods: We conducted an online national survey addressed to independent midwives in France from 29 April to 15 May 2020, around the end of the first lockdown (17 March-11 May, 2020).Results: Of the 5264 registered independent midwives in France, 1491 (28.3%) responded; 64.7% reported new or greater problems during the pandemic in referring women to health facilities or care-providers, social workers in particular, and 71.0% reported new difficulties collaborating with hospitals. Nearly half (46.2%) the respondents considered that all the women in their care had experienced, to varying degrees, a lack of or delay in care that could have affected their health. This proportion did not differ according to the midwives' form of practice: solo practice, group practice with other midwives only, or group practice with at least two types of healthcare professionals.Conclusions: The pandemic has degraded the quality of pregnant women's care in France and challenged the French model of care, which is highly compartmentalised between an almost exclusively independent primary care (community) sector and a predominantly salaried secondary care (hospital) sector. [ABSTRACT FROM AUTHOR]

Importance: The optimal approach to the use of venoarterial extracorporeal membrane oxygenation (ECMO) during cardiogenic shock is uncertain.Objective: To determine whether early use of moderate hypothermia (33-34 °C) compared with strict normothermia (36-37 °C) improves mortality in patients with cardiogenic shock receiving venoarterial ECMO.Design, Setting, and Participants: Randomized clinical trial of patients (who were eligible if they had been endotracheally intubated and were receiving venoarterial ECMO for cardiogenic shock for <6 hours) conducted in the intensive care units at 20 French cardiac shock care centers between October 2016 and July 2019. Of 786 eligible patients, 374 were randomized. Final follow-up occurred in November 2019.Interventions: Early moderate hypothermia (33-34 °C; n = 168) for 24 hours or strict normothermia (36-37 °C; n = 166).Main Outcomes and Measures: The primary outcome was mortality at 30 days. There were 31 secondary outcomes including mortality at days 7, 60, and 180; a composite outcome of death, heart transplant, escalation to left ventricular assist device implantation, or stroke at days 30, 60, and 180; and days without requiring a ventilator or kidney replacement therapy at days 30, 60, and 180. Adverse events included rates of severe bleeding, sepsis, and number of units of packed red blood cells transfused during venoarterial ECMO.Results: Among the 374 patients who were randomized, 334 completed the trial (mean age, 58 [SD, 12] years; 24% women) and were included in the primary analysis. At 30 days, 71 patients (42%) in the moderate hypothermia group had died vs 84 patients (51%) in the normothermia group (adjusted odds ratio, 0.71 [95% CI, 0.45 to 1.13], P = .15; risk difference, -8.3% [95% CI, -16.3% to -0.3%]). For the composite outcome of death, heart transplant, escalation to left ventricular assist device implantation, or stroke at day 30, the adjusted odds ratio was 0.61 (95% CI, 0.39 to 0.96; P = .03) for the moderate hypothermia group compared with the normothermia group and the risk difference was -11.5% (95% CI, -23.2% to 0.2%). Of the 31 secondary outcomes, 30 were inconclusive. The incidence of moderate or severe bleeding was 41% in the moderate hypothermia group vs 42% in the normothermia group. The incidence of infections was 52% in both groups. The incidence of bacteremia was 20% in the moderate hypothermia group vs 30% in the normothermia group.Conclusions and Relevance: In this randomized clinical trial involving patients with refractory cardiogenic shock treated with venoarterial ECMO, early application of moderate hypothermia for 24 hours did not significantly increase survival compared with normothermia. However, because the 95% CI was wide and included a potentially important effect size, these findings should be considered inconclusive.Trial Registration: ClinicalTrials.gov Identifier: NCT02754193. [ABSTRACT FROM AUTHOR]

Background: Little is known about patients who forego healthcare, although it is an important provider of unfavorable health-related outcomes. Forgoing healthcare characterizes situations in which people do not initiate or interrupt a care process, even though they perceive the need for it, whether or not this need is medically proven. The aims of this study were to assess the prevalence and the determinants of patients who forego healthcare. The second aim was to compare the characteristics of patients who gave up healthcare during the French lockdown due to COVID-19. Methods: We conducted two multicenter cross-sectional studies in 2017 and 2020 carried out in French patients presenting to the emergency departments. Patients who gave their consent to participate were interviewed with a standardized questionnaire. It consisted of two parts: epidemiological characteristics and health care refusal. A third part concerning the renunciation of care during the COVID-19 period was added to the second study period. Results: A total of 1878 patients had completed the questionnaire during the interview with the physicians, 900 during the first period in 2017 (47.9%) and 978 (52.1%) during the second period. A total of 401/1878 patients reported not seeking care in the last 12 months (21.4% [95%CI: 19.5–23.3%]). In 2020, patients forewent care more during the confinement period than outside with different characteristics of the foregoing care populations. Conclusion: Forgoing care is common in a universal health care system such as France's and increased during the pandemic. Key public health messages targeted at the reasons for not seeking care must now be disseminated in order to combat this. [ABSTRACT FROM AUTHOR]

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In order to rationalize the massive use of administrative data in the production of demographic and social statistics, the French national statistical institute (INSEE) has decided to launch a program to create a system of interconnected registers of individuals, dwellings and households. This program, called RESIL, is based on the mobilization of external data, particularly administrative data, in strict compliance with the conditions for the protection of individual data. Thus, through these registers, INSEE will have a reference universe that will allow: (i) to constitute the sampling frames as well as the calibration margins of household surveys; (ii) to measure the quality of the coverage of sources; and (iii) to match different datasets: surveys with administrative data, administrative data with administrative data in order to provide richer information. To set up this information system, INSEE will draw on international experiences, as it plans to use methodologies already implemented in several national statistical institutes, including: • deterministic and probabilistic matching methods for identifying and comparing different administrative sources. These methods are essential insofar as France does not have a unique and shared identifier; • the sign of life method to define the reference population from the presence of individuals in several input data; • the Dual System Estimation methodology to measure the quality of coverage of the registers using annual population census data (it is a real opportunity to have these annual points of comparison to assess the quality of the registers, especially during the set-up period). This paper will therefore present the stakes and the context, in particular the legal context, of the implementation of these registers, and will then describe the main methodological principles and the proofs of concept planned for its implementation. [ABSTRACT FROM AUTHOR]

• Mobile units may improve mass vaccination against COVID-19 and other pandemics. • The use of a mobile unit as vaccination center has been widely welcomed and used by the professional and target population. • The mobile vaccination unit facilitates access to isolated population. • The use of a mobile decontamination unit as a vaccination center is an innovative concept. In the context of the worldwide vaccination campaign against COVID-19, France has been deploying multiple sites for mass vaccination. This study aimed to assess the perceived usefulness of a prototype decontamination mobile unit (UMDEO) for COVID-19 vaccination among both the patient and healthcare providers perspectives. This was a descriptive cross-sectional study conducted in Toulouse over two days. UMDEO is a fully comprehensive, versatile solution that was deployed as a 5-row vaccination unit. A written questionnaire was distributed from March 6th-7th, 2021 among all patients presenting for vaccination at the mobile center, as well as the team participating in the vaccination campaign. Among the vaccinated patients (n = 1659), 1409 participants (84.9%) filled out the survey, as well as 68 out of 85 (80%) within the UMDEO team. The maximum patient rate was 98 people per hour. The majority of participants and caregivers (1307 [93.2%] and 67 [98.5%] respectively) agreed that the mobile unit increased access to vaccination. A total of 91.3% patients (n = 1281) and 95.6% caregivers (n = 65) believed that it would speed up the overall vaccination campaign. The majority of the vaccinated population and of the team participating in the survey were satisfied with the usefulness of UMDEO as a vaccination center. Toulouse is currently the only city to have used such a structure for vaccination, but it could be used as a basis for planning other mobile units to increase vaccination access. [ABSTRACT FROM AUTHOR]

Purpose This study investigates the impact of an intensive case management program on sick leave days, permanent work incapacity levels and treatment costs for severe vocational injuries set up by the French National Insurance Fund in five health insurance districts. Methods The method employed relies on a four-step matching procedure combining Coarsened Exact Matching and Propensity Score Matching, based on an original administrative dataset. Average Treatment effects on the Treated were estimated using a parametric model with a large set of covariates. Results After one-year follow-up, workers in the treatment group had higher sickness absence rates, with 22 extra days, and the program led to 2.7 (95% CI 2.3–3.1) times more diagnoses of permanent work incapacity in the treatment group. With an estimated yearly operational cost of 2,722 € per treated worker, the average total extra treatment cost was 4,569 € for treated workers, which corresponds to a cost increase of 29.2% for the insurance fund. Conclusions The higher costs found for the treatment group are mainly due to longer sick leave duration for the moderate severity group, implying higher cash transfers in the form of one-off indemnities. Even though workers in the treated group have more diagnoses of permanent work incapacity, the difference of severity between groups is small. Our results on longer sick leave duration are partly to be explained by interactions between the case managers and the occupational physicians that encouraged patients to stay longer off-work for better recovery, despite the higher costs that this represented for the insurance fund and the well-documented adverse side effects of longer periods off-work. [ABSTRACT FROM AUTHOR]

Since early 2020, the COVID-19 pandemic has led to lockdowns at national scales. These lockdowns resulted in large cuts of atmospheric pollutant emissions, notably related to the vehicular traffic source, especially during spring 2020. As a result, air quality changed in manners that are still currently under investigation. The robust quantitative assessment of the impact of lockdown measures on ambient concentrations is however hindered by weather variability. In order to circumvent this difficulty, an innovative methodology has been developed. The Analog Application for Air Quality (A 3 Q) method is based on the comparison of each day of lockdown to a group of analog days having similar meteorological conditions. The A 3 Q method has been successfully evaluated and applied to a comprehensive in situ dataset of primary and secondary pollutants obtained at the SIRTA observatory, a suburban background site of the megacity of Paris (France). The overall slight decrease of submicron particulate matter (PM 1) concentrations (-14 %) compared to business-as-usual conditions conceals contrasting behaviors. Primary traffic tracers (NO x and traffic-related carbonaceous aerosols) dropped by 42 %–66 % during the lockdown period. Further, the A 3 Q method enabled us to characterize changes triggered by NO x decreases. Particulate nitrate and secondary organic aerosols (SOAs), two of the main springtime aerosol components in northwestern Europe, decreased by -45 % and -25 %, respectively. A NO x relationship emphasizes the interest of NO x mitigation policies at the regional (i.e., city) scale, although long-range pollution advection sporadically overcompensated for regional decreases. Variations of the oxidation state of SOA suggest discrepancies in SOA formation processes. At the same time, the expected ozone increase (+20 %) underlines the negative feedback of NO titration. These results provide a quasi-comprehensive observation-based insight for mitigation policies regarding air quality in future low-carbon urban areas. [ABSTRACT FROM AUTHOR]

The Eocene–Oligocene Transition (EOT) marks the onset of the Antarctic glaciation and the switch from greenhouse to icehouse climates. However, the driving mechanisms and the precise timing of the EOT remain controversial mostly due to the lack of well-dated stratigraphic records, especially in continental environments. Here we present a cyclo-magnetostratigraphic and sedimentological study of a ∼ 7.6 Myr long lacustrine record spanning the late Eocene to the earliest Oligocene, from a drill core in the Rennes Basin (France). Cyclostratigraphic analysis of natural gamma radiation (NGR) log data yields duration estimates of Chrons C12r through C16n.1n, providing additional constraints on the Eocene timescale. Correlations between the orbital eccentricity curve and the 405 kyr tuned NGR time series indicate that 33.71 and 34.10 Ma are the most likely proposed ages of the EO boundary. Additionally, the 405 kyr tuning calibrates the most pronounced NGR cyclicity to a period of ∼ 1 Myr, matching the g1–g5 eccentricity term, supporting its significant expression in continental depositional environments, and hypothesizing that the paleolake level may have behaved as a low-pass filter for orbital forcing. Two prominent changes in the sedimentary facies were detected across the EOT, which are temporally equivalent to the two main climatic steps, EOT-1 and Oi-1. We suggest that these two facies changes reflect the two major Antarctic cooling/glacial phases via the hydrological cycle, as significant shifts to drier and cooler climate conditions. Finally, the interval spanning the EOT precursor glacial event through EOT-1 is remarkably dominated by obliquity. This suggests preconditioning of the major Antarctic glaciation, either from obliquity directly affecting the formation/(in)stability of the incipient Antarctic Ice Sheet (AIS), or through obliquity modulation of the North Atlantic Deep Water production. [ABSTRACT FROM AUTHOR]

Aims: Intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy is standard care for neovascular age-related macular degeneration (nAMD), but the recommended monthly injection regimen is burdensome. Evidence suggests low injection/monitoring frequencies in clinical practice and suboptimal vision outcomes. This observational cohort study uses administrative claims data from the French national healthcare system to assess anti-VEGF treatment patterns and nAMD-specific healthcare resource demands and costs. Patients and methods: nAMD patients ≥50 years initiating intravitreal ranibizumab, aflibercept or bevacizumab treatment (2014-2015), and propensity score-matched non-nAMD patients (controls), were identified from the Echantillon G≥enéraliste de Bénéficiaires database. Outcomes of interest included anti-VEGF treatment patterns, and healthcare resource utilization and associated costs of patients vis-á-vis controls over 24 months. Results: Study patients (n=355) received (mean) 5.2 and 2.4 anti-VEGF injections over 0-12 and 12-24 months, respectively. Most patients (79.0%) remained on their initial anti-VEGF agent; among treatment switchers, the most common transition was from ranibizumab to aflibercept. During followup, nAMD patients were more likely than controls to require ophthalmology visits (99.7% vs. 44.8%), ocular procedures (optical coherence tomography/angiography/fundoscopy) (96.9% vs. 27.2%), cataract surgery (13.0% vs. 6.7%), and medical transports (38.0% vs. 31.9%). Mean numbers of ophthalmology visits (25.1 vs. 1.2) and medical transports (6.0 vs. 3.5) were higher (p<.01) among nAMD patients. Total reimbursed costs were two-fold higher for nAMD patients than controls (mean e16,799 vs. e8,255) due to higher treatment costs (e6,847 vs. e1,156), medical fees (e1,858 vs. e295), hospital fees (e6,396 vs. e5,235), and transport costs (e358 vs. e259). Excess total healthcare cost was (mean) e5,279 and e7,918 over the first 12 and 24 months of treatment, respectively. Conclusions: Current intravitreal anti-VEGF treatment and monitoring requirements place a considerable economic burden on the French healthcare system. New intravitreal therapies with extended dosing intervals and predictable efficacy might reduce demand for ophthalmology services. [ABSTRACT FROM AUTHOR]

Background: Many studies reported that reproductive desire could be high among transgender individuals. In France, fertility preservation and sperm donation were very little proposed to transgender individuals until recently, mainly because the Bioethics Law allows the use of assisted reproductive technologies only in infertile couples and prohibits surrogacy. Objectives: To evaluate the distribution of care on the French territory concerning fertility preservation and sperm donation in transgender individuals. Materials and methods: A multicentric national survey was carried out between January 2019 and October 2020 in 28 assisted reproductive technology centres of the French CECOS (Centres d'Etudes et de Conservation des Oeufs et du Sperme) network. Each centre was questioned to find out how many transgender individuals came, were informed and cared for fertility preservation and sperm donation. Results: Concerning fertility preservation, 71.4% of centres received transgender individuals and performed gamete cryopreservation; 581 transgender individuals consulted for fertility preservation. Transgender women were more likely to desire (p < 0.0001) and achieve (p < 0.0001) fertility preservation than transgender men. Concerning sperm donation in couples including a transgender man, 68% of centres offer the complete course from the first consultation to the completion of the assisted reproductive technology cycles; 122 offsprings have been conceived with sperm donation in couples including a transgender man since 1999. Discussion: Our results showed that even if all centres do not propose fertility preservation or sperm donation in transgender individuals, these assisted reproductive technologies are present throughout the French territory. The major point is that both fertility preservation and sperm donation in transgender individuals have grown significantly and that the care of these patients is improving year after year. Conclusion: In France, most of CECOS centres can take care of transgender individuals for fertility preservation and sperm donation. The French Bioethics Law allows these latter, and transgender individuals can benefit from a financial support of the national health care insurance for fertility preservation and sperm donation. [ABSTRACT FROM AUTHOR]

• Globally more than 3 million tons of river driftwood are extracted annually. • Driftwood transportations eliminate bark without degrading the macromolecules. • Wood fraction of river driftwood has similar properties to fresh wood. • River driftwood can be thermally processed without any prior separation. Driftwood in river catchments might pose a hazard for the safety of infrastructures, such as dams and river dwellers, and thus is often removed. Génissiat dam in France presents a case study where annually approximately 1300 tons of driftwood are removed to prevent driftwood sinking and to protect the dam infrastructure. Collected river driftwood is rarely studied for utilization purposes and is commonly combusted or landfilled. However, driftwood can be valorized for biochar production through pyrolysis or hydrothermal carbonization (HTC). This study follows a novel approach in characterizing river driftwood by identifying the different common genera present at Génissiat dam on the upper Rhône, France. Moreover, the research provides for the first time a comprehensive analysis of river driftwood different physico-chemical properties, such as moisture content, major elemental composition (CHNSO), HHV, and macromolecular composition (cellulose, hemicellulose, lignin, and extractives). The study shows that the transportation of driftwood through rivers can enhance its properties by reducing the bark content resulting in lower ash content. Results indicate that driftwood can be mixed and further processed as a feedstock regardless of their genera and type for biochar production by pyrolysis or hydrothermal carbonization. [ABSTRACT FROM AUTHOR]

Background Infective endocarditis (IE) is a severe disease requiring microbial identification to successfully adapt its treatment. Currently, identification of its etiological microorganism remains unresolved in 5.2% of cases. We aimed to improve IE diagnosis using an ultra-sensitive molecular technique on cardiac samples in microbiologically nondocumented (culture and conventional polymerase chain reaction [PCR]) IE (NDIE) cases. Methods Cardiac samples explanted in a tertiary hospital in Lyon, France, from patients with definite IE over a 5-year period were retrospectively analyzed. NDIE was defined as Duke definite-IE associated with negative explorations including cardiac samples culture, bacterial amplification, and serologies. Ultrasensitive molecular diagnosis was achieved using the Universal Microbe Detection kit (Molzym®). Fungal identification was confirmed using 26S-rDNA and internal transcribed spacer amplifications. Fungal infection was confirmed using Grocott-Gromori staining, auto-immunohistochemistry on cardiac samples, and mannan serologies. Results Among 88 included patients, microbial DNA was detected in all 16 NDIE cases. Bacterial taxa typical of IE etiologies were detected in 13/16 cases and Malassezia restricta in the 3 other cases. In these 3 cases, histological examination confirmed the presence of fungi pathognomonic of Malassezia that reacted with patient sera in an auto-immunohistochemistry assay and cross-reacted with Candida albicans in an indirect immunofluorescent assay. Conclusions M. restricta appears to be an underestimated causative agent of NDIE. Importantly, serological cross-reaction of M. restricta with C. albicans may lead to its misdiagnosis. This is of major concern since M. restricta is intrinsically resistant to echinocandins; the reference treatment for Candida -fungal IE. [ABSTRACT FROM AUTHOR]

Background: Quality care during childbirth requires that health care providers have not only excellent skills but also appropriate and considerate attitudes and behavior. Few studies have examined the proportion of women in Western countries expressing dissatisfaction with such inappropriate or inconsiderate behavior. This study evaluated this proportion in a sample presumably representative of French maternity units. Methods: This prospective multicenter study, using data from a selfadministered questionnaire, took place in 25 French maternity units during one week in September 2018. The primary outcome measure was mothers' self‐reported dissatisfaction with blatantly inappropriate behavior (ie, inappropriate attitude, inadequate respect for privacy, insufficient gentleness of care, and/or inappropriate language) by health care workers in the delivery room. The secondary outcome was their self‐reported dissatisfaction with these workers' inconsiderate behavior (ie, unclear and inappropriate information, insufficient participation in decision‐making, or deficient consideration of pain). Results: Of 803 potentially eligible women, 627 completed the questionnaire after childbirth; 5.62% (35/623, 95% CI: 3.94‐7.73) reported dissatisfaction with blatantly inappropriate behaviors and 9.79% (61/623, 95% CI: 7.57‐12.40) with inconsiderate behaviors. The main causes of dissatisfaction reported by women in this survey were the inadequate consideration of their pain and the failure to share decision‐making. Conclusions: Most of the women were satisfied with how health care workers behaved towards them in the delivery room. Nonetheless, health care staff must be aware of women's demands for greater consideration of their expressions of pain and of their voice in decisions. [ABSTRACT FROM AUTHOR]

As native ranges are often geographically structured, invasive species originating from a single source population only carry a fraction of the genetic diversity present in their native range. The invasion process is thus often associated with a drastic loss of genetic diversity resulting from a founder event. However, the fraction of diversity brought to the invasive range may vary under different invasion histories, increasing with the size of the propagule, the number of reintroduction events, and/or the total genetic diversity represented by the various source populations in a multiple‐introduction scenario. In this study, we generated a SNP data set for the invasive termite Reticulitermes flavipes from 23 native populations in the eastern United States and six introduced populations throughout the world. Using population genetic analyses and approximate Bayesian computation random forest, we investigated its worldwide invasion history. We found a complex invasion pathway with multiple events out of the native range and bridgehead introductions from the introduced population in France. Our data suggest that extensive long‐distance jump dispersal appears common in both the native and introduced ranges of this species, probably through human transportation. Overall, our results show that similar to multiple introduction events into the invasive range, admixture in the native range prior to invasion can potentially favour invasion success by increasing the genetic diversity that is later transferred to the introduced range. [ABSTRACT FROM AUTHOR]

To assess the practicability (usability and satisfaction) and analytical performances of the VitaPCR™ SARS‐CoV‐2 Assay (Credo Diagnostics Biomedical Pte. Ltd.), a rapid point‐of‐care nucleic acid amplification test (NAAT), by reference to real‐time reverse‐transcription polymerase chain reaction (rRT‐PCR) for respiratory viruses. The practicability of the VitaPCR™ Assay and Instrument was assessed from usability evaluation and a satisfaction questionnaire. Nasopharyngeal swabs were collected from 239 patients with coronavirus disease 2019 (COVID‐19)‐like illness during the second epidemic wave, in Paris, France. Overall, the usability of the VitaPCR™ Instrument was high. The satisfaction questionnaire indicated a high appreciation of the VitaPCR™ NAAT mainly for the short duration of analysis in only 20 min. A total of 140 and 99 samples were positive and negative for SARS‐CoV‐2 RNA by rRT‐PCR, respectively. In the event of significant viral load (i.e., N gene Ct values 33), the platform's analytical performances dropped significantly, with lower sensitivity, concordance, and accuracy, while its specificity remained high. The VitaPCR™ SARS‐CoV‐2 Assay is an accurate rapid point‐of‐care NAAT, suitable for clinical practice for the rapid diagnosis of COVID‐19, especially in patients with COVID‐19‐suspected symptoms. [ABSTRACT FROM AUTHOR]

The Atlantic coast of north-west France is one of the classic shell-midden regions of the European Mesolithic, made famous by the excavations of Téviec and Hoedic in the first half of the 20th century. At this time, there was a lack of interest in the food refuse component of shell middens. By the end of the 1990s new study methods and techniques had also contributed to a better description of the varied activities of these coastal populations. In Atlantic France, new excavations have demonstrated that shell middens are not a site type but rather one of a variety of stratigraphic units that make up the total settlement pattern. Our perception of the Mesolithic hunter-gatherers of the French Atlantic coast has now changed from a population pre-occupied with day-to-day survival and forced to eat shellfish out of necessity, to fisher-hunter-gatherers involved in varied activities. Their knowledge of marine biotopes is revealed by the diversity of marine animals dedicated to food, but also by the collection of other raw materials washed up on the beach , including flint or shells devoid of flesh. The latter give us access to the symbolic sphere and were clearly and carefully selected for ornamental purposes. [ABSTRACT FROM AUTHOR]

Background: Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection causes direct lung damage, overwhelming endothelial activation, and inflammatory reaction, leading to acute respiratory failure and multi-organ dysfunction. Ongoing clinical trials are evaluating targeted therapies to hinder this exaggerated inflammatory response. Critically ill coronavirus disease 2019 (COVID-19) patients have shown heterogeneous severity trajectories, suggesting that response to therapies is likely to vary across patients.Research Question: Are critically ill COVID-19 patients biologically and immunologically dissociable based on profiling of currently evaluated therapeutic targets?Study Design and Methods: We did a single-center, prospective study in an ICU department in France. Ninety-six critically ill adult patients admitted with a documented SARS-CoV-2 infection were enrolled. We conducted principal components analysis and hierarchical clustering on a vast array of immunologic variables measured on the day of ICU admission.Results: We found that patients were distributed in three clusters bearing distinct immunologic features and associated with different ICU outcomes. Cluster 1 had a "humoral immunodeficiency" phenotype with predominant B-lymphocyte defect, relative hypogammaglobulinemia, and moderate inflammation. Cluster 2 had a "hyperinflammatory" phenotype, with high cytokine levels (IL-6, IL-1β, IL-8, tumor necrosis factor-alpha [TNF⍺]) associated with CD4+ and CD8+ T-lymphocyte defects. Cluster 3 had a "complement-dependent" phenotype with terminal complement activation markers (elevated C3 and sC5b-9).Interpretation: Patients with severe COVID-19 exhibiting cytokine release marks, complement activation, or B-lymphocyte defects are distinct from each other. Such immunologic variability argues in favor of targeting different mediators in different groups of patients and could serve as a basis for patient identification and clinical trial eligibility. [ABSTRACT FROM AUTHOR]

Summary: Acquired factor V inhibitor (AFVI) is an extremely rare disorder that may cause severe bleeding. To identify factors associated with bleeding risk in AFVI patients, a national, multicentre, retrospective study was made including all AFVI patients followed in 21 centres in France between 1988 and 2015. All patients had an isolated factor V (FV) deficiency <50% associated with inhibitor activity. Patients with constitutional FV deficiency and other causes of acquired coagulation FV deficiencies were excluded. The primary outcome was incident bleeding and factors associated with the primary outcome were identified. Thirty‐eight (74 [36–100] years, 42·1% females) patients with AFVI were analysed. Bleeding was reported in 18 (47·4%) patients at diagnosis and in three (7·9%) during follow‐up (7 [0·2–48.7] months). At diagnosis, FV was <10% in 31 (81·6%) patients. Bleeding at diagnosis was associated with a prolonged prothrombin time that strongly correlated with the AFVI level measured in plasma {r = 0·63, 95% confidence interval (CI) [0·36–0·80], P < 0·05}. Bleeding onset during follow‐up was associated with a slow AFVI clearance (P < 0·001). The corresponding receiver operating characteristics curve showed that AFVI clearance was predictive of bleeding onset with an AFVI clearance of seven months with a sensitivity of 100% (95% CI: 29–100) and a specificity of 86% (95% CI: 57–98, P = 0·02). Kaplan–Meier analysis showed that AFVI clearance >7 months increased the risk of bleeding by 8 (95% CI: [0·67–97], P = 0·075). Prothrombin time at diagnosis and time for clearance of FV inhibitor during follow‐up are both associated with bleeding in patients with AFVI. [ABSTRACT FROM AUTHOR]

An indirect in-house immunofluorescent assay was developed in order to assess the serological status of COVID-19 patients in Marseille, France. Performance of IFA was compared to a commercial ELISA IgG kit. We tested 888 RT-qPCR-confirmed COVID-19 patients (1302 serum samples) and 350 controls including 200 sera collected before the pandemic, 64 sera known to be associated with nonspecific serological interference, 36 sera from non-coronavirus pneumonia and 50 sera from patient with other common coronavirus to elicit false-positive serology. Incorporating an inactivated clinical SARS-CoV-2 isolate as the antigen, the specificity of the assay was measured as 100% for IgA titre ≥ 1:200, 98.6% for IgM titre ≥ 1:200 and 96.3% for IgG titre ≥ 1:100 after testing a series of negative controls. IFA presented substantial agreement (86%) with ELISA EUROIMMUN SARS-CoV-2 IgG kit (Cohen's Kappa = 0.61). The presence of antibodies was then measured at 3% before a 5-day evolution up to 47% after more than 15 days of evolution. We observed that the rates of seropositivity as well as the titre of specific antibodies were both significantly higher in patients with a poor clinical outcome than in patients with a favourable evolution. These data, which have to be integrated into the ongoing understanding of the immunological phase of the infection, suggest that detection anti-SARS-CoV-2 antibodies is useful as a marker associated with COVID-19 severity. The IFA assay reported here is useful for monitoring SARS-CoV-2 exposure at the individual and population levels. [ABSTRACT FROM AUTHOR]

This article presents a new cloud radar calibration methodology using solid reference reflectors mounted on masts, developed during two field experiments held in 2018 and 2019 at the Site Instrumental de Recherche par Télédétection Atmosphérique (SIRTA) atmospheric observatory, located in Palaiseau, France, in the framework of the Aerosol Clouds Trace gases Research InfraStructure version 2 (ACTRIS-2) research and innovation program. The experimental setup includes 10 and 20 cm triangular trihedral targets installed at the top of 10 and 20 m masts, respectively. The 10 cm target is mounted on a pan-tilt motor at the top of the 10 m mast to precisely align its boresight with the radar beam. Sources of calibration bias and uncertainty are identified and quantified. Specifically, this work assesses the impact of receiver compression, temperature variations inside the radar, frequency-dependent losses in the receiver's intermediate frequency (IF), clutter and experimental setup misalignment. Setup misalignment is a source of bias, previously undocumented in the literature, that can have an impact of the order of tenths of a decibel in calibration retrievals of W-band radars. A detailed analysis enabled the quantification of the importance of each uncertainty source to the final cloud radar calibration uncertainty. The dominant uncertainty source comes from the uncharacterized reference target which reached 2 dB. Additionally, the analysis revealed that our 20 m mast setup with an approximate alignment approach is preferred to the 10 m mast setup with the motor-driven alignment system. The calibration uncertainty associated with signal-to-clutter ratio of the former is 10 times smaller than for the latter. Following the proposed methodology, it is possible to reduce the added contribution from all uncertainty terms, excluding the target characterization, down to 0.4 dB. Therefore, this procedure should enable the achievement of calibration uncertainties under 1 dB when characterized reflectors are available. Cloud radar calibration results are found to be repeatable when comparing results from a total of 18 independent tests. Once calibrated, the cloud radar provides valid reflectivity values when sampling midtropospheric clouds. Thus, we conclude that the method is repeatable and robust, and that the uncertainties are precisely characterized. The method can be implemented under different configurations as long as the proposed principles are respected. It could be extended to reference reflectors held by other lifting devices such as tethered balloons or unmanned aerial vehicles. [ABSTRACT FROM AUTHOR]

PURPOSE Psychological health at work for care providers is an important issue, because they are directly involved in quality of patient care.Managerial and organizational determinants have been found to be indicators of psychological health at work. The main objective of this study was to explore the relationships between the psychological health at work of pediatric oncology care workers with managerial and organizational determinants and with quality of care. MATERIALS AND METHODS We performed regression analysis between psychological health at work (quality of work life [QWL], job satisfaction, and so on), managerial determinants (transformational leadership, perceived autonomy support), organizational determinants (organizational support, organizational justice, and participatory approach), and perceived quality of care. RESULTS Participants were 510 health care professionals working in French pediatric oncology centers. No significant differences in the psychological health at work of the participants were found based on age, sex, length of employment, or professional discipline. In simple regression, significant associations were found between psychological health at work with all managerial and organizational determinants. In multiple regression, a significant link was found between QWL and perceived organizational support (β = .21; P < .001), organizational justice (β = .20, P,.001), and overall participatory approach (β = .10; P,.02). Job satisfaction was also related to perceived organizational support (β = .16; P < .01). Finally, perceived quality of care was linked to QWL (β = .15; P < .01) and job satisfaction (β = .30; P < .001). CONCLUSION These results emphasize the importance of the role of managers and the organization in psychological health at work of health care providers and also in the quality of patient care [ABSTRACT FROM AUTHOR]

Purpose: Coronavirus disease 2019 (COVID-19) is creating an unprecedented healthcare crisis. Understanding the determinants of mortality is crucial to optimise intensive care unit (ICU) resource use and to identify targets for improving survival.Methods: In a multicentre retrospective study, we included 379 COVID-19 patients admitted to four ICUs between 20 February and 24 April 2020 and categorised according to time from disease onset to ICU admission. A Cox proportional-hazards model identified factors associated with 28-day mortality.Results: Median age was 66 years (53-68) and 292 (77%) were men. The main comorbidities included obesity and overweight (67%), hypertension (49.6%) and diabetes (30.1%). Median time from disease onset (i.e., viral symptoms) to ICU admission was 8 (6-11) days (missing for three); 161 (42.5%) patients were admitted within a week of disease onset, 173 (45.6%) between 8 and 14 days, and 42 (11.1%) > 14 days after disease onset; day 28 mortality was 26.4% (22-31) and decreased as time from disease onset to ICU admission increased, from 37 to 21% and 12%, respectively. Patients admitted within the first week had higher SOFA scores, more often had thrombocytopenia or acute kidney injury, had more limited radiographic involvement, and had significantly higher blood IL-6 levels. Age, COPD, immunocompromised status, time from disease onset, troponin concentration, and acute kidney injury were independently associated with mortality.Conclusion: The excess mortality in patients admitted within a week of disease onset reflected greater non-respiratory severity. Therapeutic interventions against SARS-CoV-2 might impact different clinical endpoints according to time since disease onset. [ABSTRACT FROM AUTHOR]